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The purpose of this research was to assess the preferred route of nutrition support (enteral versus parenteral) for treatment of severe acute pancreatitis in the acute care setting. Further, in cases when enteral nutrition is the preferred route, is nasal‐bridling a lower‐morbidity and cost‐effective method?

A retrospective review of pre‐existing data from an 870‐bed hospital system. Medical records were reviewed via an online database system (n=25\; patients) with severe acute pancreatitis. Length of stay and cost were analyzed.

More patients received TPN versus the nasal‐jejunal (post‐pyloric) tube feeds group. No significant relationship was found between total cost and number of co‐morbidities or between either of the two treatment groups. However, a medium to large effect size was shown which could indicate a significant relationship in a larger sample size.

The findings of this research add to the literature already available and will be of interest to those who specialize in this area.

The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service.

A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content.

Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols.

This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.

Nutrition plays a key role in the recovery of pediatric trauma patients. A catabolic state in trauma patients may hinder recovery and inadequate nutrition may increase morbidity, mortality and length of hospital stay. The purpose of this paper is to review the current nutrition support practices for pediatric trauma patients at McMaster Children’s Hospital (MCH), describe patient demographics and identify areas to improve the quality of patient care.

A retrospective chart review was conducted on pediatric trauma patients (age<18 years) identified through the trauma registry of MCH. Pediatric trauma patients admitted from January 2010 to March 2014 with an Injury Severity Score (ISS)=12 and a hospitalization of =24 hours were included.

In total, 130 patients were included in this study, 61.1 percent male, median age ten years (range: 0-17 years) and median ISS of 17 (range: 12-50). Blunt trauma accounted for 97.7 percent of patients admitted and 73.3 percent had trauma team activation. In total, 93 patients (71.5 percent) had ICU stays. The median time to feed was 29 hours (interquartile range: 12.5-43 hours) from the time of admission. An increased hospital length of stay was associated with longer time to initiation of nutrition support, a higher ISS and greater number of surgeries (p<0.05).

Local nutritional support practices for pediatric trauma patients correspond with recommended principles of early feeding and preferential enteral nutrition. Harmonization of paper-based and electronic data collection is recommended to ensure that prescribed nutritional support is being delivered and nutritional needs of pediatric trauma patients are being met.

Points out that the Department of Health’s Executive Letter: EL(95)5 moved the finance of high technology treatment provided at home for chronically ill patients from the NHS prescribing budget onto a defined and consistent framework. The aim was to obtain better value for money by encouraging competition between potential homecare providers. Reports on a survey of prescribing advisers of purchasing health authorities, which focused on their response to these developments, and discusses the issues identified by purchasers in their implementation of EL(95)5. Notes that, although most purchasers chose to contract directly with a single commercial homecare organization in 1995‐1996, there was no consensus about where contracts should be placed in the future, and that the purchasers identified inefficiencies in contracting for such care. Discusses methods of improving the purchasers’ response to contracting.

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

This study examined the provision of high‐tech home care by Quebec primary care organizations (CLSCs). Four technologies were selected: IV antibiotic therapy, oxygen therapy, parenteral nutrition, and peritoneal dialysis. A postal survey was sent to all CLSCs and a response rate of 69 percent was obtained; 57 percent of CLSCs have been involved in the provision of services related to three of the high‐tech interventions. The most frequently used sources of information are written material provided by manufacturers or by hospitals. CLSCs relied heavily on peer‐to‐peer training and training provided by manufacturers and hospitals. Formal agreements with hospitals regarding patient flow management were established; aspects related to the “content” of care were much less formalized. CLSCs have integrated high‐tech home care to a substantial extent. Our findings raise quality‐of‐care issues. The interface with hospitals needs to be reinforced and emphasis given to the appropriate use of technology.

High‐technology treatments such as total parenteral nutrition or intravenous antibiotics may increasingly be provided to patients at home. In the past, these services have been funded by the NHS prescribing budget. The aim of the Department of Health’s Executive letter EL(95)5, Purchasing High Tech Healthcare for Patients at Home was to ensure that contracts placed by health authority purchasers maintain effective patient services and obtain better value for money by encouraging competition between potential homecare providers. Examines contracting for high‐tech health care for patients at home and suggests that efficiency could be improved when contracting with commercial home‐care organizations by lead purchasing arrangements. In the long‐term, contracting with NHS tertiary centres is most likely to ensure continuity of care and appropriate clinical monitoring of patients.

The purpose of this paper is to report the assessment results of the quality of neonatal care services in Armenia and to describe the identified obstacles to improving the quality of care for newborn infants.

The study carried out a cross-sectional descriptive design. The data were collected in health facilities with different levels of neonatal care that were selected employing a multi-stage, stratified purposeful sampling design. The quality of neonatal services was assessed using the generic WHO tool. Data collection was performed using face-to-face semi-structured interviews, hospital statistics, medical records and direct observations.

In 31 study hospitals, 31,976 deliveries were performed resulting in 31,701 live births and 734 stillbirths. About 85 percent of all neonatal deaths was attributable to early neonatal deaths with over 48 percent occurring during the first 24 h of life. The proportion of neonatal deaths was highest in infants with low birth weight constituting 92.8 percent of all neonatal deaths. The total neonatal mortality rate was 3.50 per 1,000 live births, whereas stillbirth rate and perinatal mortality rate were 22.60 and 25.26 per 1,000 total births in 2015. Specific indicators with relatively lower mean scores included neonatal resuscitation, early breastfeeding, monitoring of newborn conditions, neonatal sepsis, feeding standards, total parenteral nutrition, and infection treatment.

Given the limited scope of research on quality assessment, this paper provides valuable information on the status of quality of neonatal care services in Armenian health facilities. This work also extends the existing studies focused on quality assessment through applying the model of Avedis Donabedian with the structure–process–outcomes approach as a theoretical basis.

The purpose of this paper is to identify the extent of actual malnutrition and its risk among cancer patients receiving radiotherapy and/or chemotherapy in the Libyan city of Benghazi.

A cross‐sectional nutritional assessment study using the patient‐generated subjective global assessment (PG‐SGA) was carried out on 200 (91 males and 109 females) cancer patients undergoing chemotherapy and/or radiotherapy.

A total of 25 per cent of the subjects were severely malnourished while 73.5 per cent were either at risk of malnutrition or suspected to be malnourished. Almost all (99.5 per cent) needed some degree of intervention (critical in nature for 83.5 per cent). Family income and physical activity were associated with nutritional status (p<0.05). Body Mass Index alone is an insensitive criterion for identifying malnutrition among such patients. All the sections and subsections of the PG‐SGA had a statistically significant positively correlation with its total score (r=0.51‐0.96, p<0.05). Dieticians played a very limited role in patient nutritional care.

It is suggested that dieticians should play a more participatory and prominent role in a multidisciplinary team involved in patient nutritional care. The PG‐SGA can help identify areas where tailor made strategies to counteract specific malnutrition or its risk can be planned, implemented and monitored.

There exists a considerable prevalence of malnutrition among Benghazi cancer patients undergoing chemotherapy and/or radiotherapy, most of whom need critical intervention.

Catheter related blood stream infection (CRBSI) remains an important complication of central venous catheters(CVCs). Educational programmes have been associated with CRBSI reduction but evidence in total parenteral nutrition (TPN) patients is limited, despite an increased risk of CRBSI. The effect of educational processes were evaluated and the value of different methods of expression of CRBSI incidence were assessed.

Study was performed in a 525‐bed tertiary university hospital over 12 years. A multidisciplinary TPN committee was created to examine CRBSI episodes and a parallel education programme was set up and maintained. Prospectively collected data were analysed from 1,392 patients in whom 2,565 CVCs were used over 15,397 CVC days. CRBSI incidence was expressed as CRBSI episodes per 1,000 CVC days, percentage patients or percentage CVCs infected.

CRBSI incidence fell from 33 to 7 episodes per 1,000 CVC days (p<0.01). Percentage of infected CVCs fell from 17 per cent to 5 per cent(p <0.05) and proportion of patients affected fell from 27 per cent to 7 per cent(p <0.01). The corresponding slopes of the lines expressing fall in CRBSI rate were −1.3‐0.63 and −1.4 respectively.

A sustained educational programme was associated with a significant fall in CRBSI in TPN patients. An incidence of 5‐7 episodes per 1,000 CVC days, a figure comparable with non‐TPN CVCs, was achievable.

Each method of expression of CRBSI incidence proved valid in this setting and contributed to the educational programme.

The value of this study is that it demonstrates how implementing and sustaining an education programme can achieve reduced rates of infection. No published study utilising all methods of expressing CRBSI incidence could be found.